Unfiltered traffic-related air associated with immediate, significant blood pressure increase

Embargoed for release until 5:00 p.m. ET on Monday 27 November 2023
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. Unfiltered traffic-related air associated with immediate, significant blood pressure increase  

Effects of exposure persisted more than 24 hours 

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1309  
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A randomized crossover trial found that the inhalation of traffic-related air pollution while in a car with unfiltered air was associated with a 4.5 mm Hg increase in blood pressure. This change in blood pressure occurred rapidly, peaked within 60 minutes of exposure, and persisted over 24 hours. The findings are published in Annals of Internal Medicine.  

Traffic-related air pollution (TRAP) exposure is recognized as a risk factor for cardiovascular disease and other health effects. Work commute times in the U.S. are longer, averaging 27 minutes in 2019. Exposure to TRAP has been associated with increased cardiovascular risk in observational studies. TRAP may include ultrafine particles; black carbon; oxides of nitrogen; carbon monoxide (CO); carbon dioxide (CO2); and other particulate matter.  

In this study from the University of Washington, 16 persons aged 22 to 45 years of age were driven through traffic in Seattle, Washington for 3 days between 2014 and 2016 to determine—by using particle filtration or sham filters—the effect of on-roadway pollutant exposure on blood pressure. For 2 days, on-road air was entrained into the vehicle. On another day, the vehicle was equipped with high efficiency particulate air (HEPA) filtration. Blood pressure was monitored up to 24 hours before, during, and after the drive. The authors found that—in the participants with complete data—drives in vehicles with unfiltered TRAP resulted in significant net increases in blood pressure compared with drives with in-vehicle filtration. According to the authors, these findings suggest that not only does TRAP raise blood pressure, but also that the effects of air pollution on blood pressure may be reduced with effective cabin air filtration. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Joel D. Kaufman, MD, MPH, please email joelk@uw.edu.

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2. Two-week prophylaxis may mitigate HCV infection in uninfected kidney transplant recipients 

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2682  

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A research report evaluating the transplantation of kidneys from donors with hepatitis C virus (HCV) viremia for recipients without HCV found that the use of direct-acting antiviral (DAA) prophylaxis for 2 weeks may prevent HCV transmission . The report is published in Annals of Internal Medicine.  

The use of organs from donors with HCV viremia for recipients without HCV with DAA prophylaxis can increase access to kidney transplant (KT). Giving DAA prophylaxis immediately before transplant to  recipients without HCV is an alternative to the transmit-and-treat approach where DAAs are given after transplant, once the recipient is already infected. Transmit-and-treat cures HCV, however, some recipients treated with this approach develop donor-specific antibodies, rejection, BK and cytomegalovirus viremia, and severe fibrosing cholestatic HCV. These complications may be avoided with prophylaxis, which is also less costly than a full treatment course. However, the optimal duration of prophylaxis is unknown.  

Researchers from Johns Hopkins University and New York University conducted a small, uncontrolled trial of 10 persons eligible for kidney transplant without HCV. Eligible deceased donors were r HCV viremic. Participants received a dose of glecaprevir (300 mg)–pibrentasvir (120 mg) prophylaxis before the KT, then once daily for 13 additional doses after the KT. The authors report that all 10 participants remained HCV-negative after 2-week DAA prophylaxis; only one participant had transient laboratory abnormalities in liver function. According to the authors, this study provides proof of concept for 2-week DAA prophylaxis as the optimal duration. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding authors, please contact Christine M. Durand, MD at christinedurand@jhmi.edu, or Niraj M. Desai, MD, at ndesai13@jhmi.edu.

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3. Thyroidectomy may improve symptoms in some patients with Hashimoto disease 

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1593   

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A research report evaluating health outcomes for patients with Hashimoto thyroiditis and persistent symptoms despite taking thyroid medications found that a thyroidectomy intervention relieved symptoms for patients 5 years later. However, 14 percent of these patients experienced complications after surgery. The report is published in Annals of Internal Medicine.  

Even when thyroxine is adequately replaced for hypothyroidism, patients with Hashimoto disease may report persistent extrathyroidal symptoms, including chronic fatigue, muscle and joint tenderness, dry mouth and eyes, and poor sleep quality. It has been hypothesized that these persistent symptoms may be related to extrathyroidal autoimmune reactions, and that complete removal of thyroid tissues may relieve symptoms. 

Researchers from Telemark Hospital, Norway conducted a randomized, open-label clinical trial of 150 persons with Hashimoto disease who reported persistent symptoms despite interventions with thyroid hormone medication. The authors evaluated self-reported quality-of-life changes in patients who received thyroidectomy and patients who received only medical treatment over 18 months. They found that patients who received thyroidectomy reported quality-of-life improvements at both 18 months and 5 years after surgical intervention compared with patients receiving medication-only treatment. However, the authors caution that 10 of the 73 participants who received thyroidectomy experienced  health complications in terms of recurrent laryngeal nerve paralysis and hypoparathyroidism.  

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Geir Hoff, MD, PhD, please telephone +47 91866762 or e-mail hofg@kreftregisteret.no.  

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4. Commentary: Communicating value of flu vaccines to patients is critical 

Authors highlight the benefits of influenza vaccination and tools, including the ‘SHARE’ method, to make physician/patient communication easier 

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2802   

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Influenza vaccinations have been regularly recommended to all Americans starting from 6 months of age for over a decade, but vaccinations among children and younger adults have usually remained low. During the COVID-19 pandemic, annual influenza vaccination coverage rates remained low overall and declined in some groups. The United States experienced high levels of influenza virus, SARS-CoV-2, and respiratory syncytial virus co-circulation during the 2022 to 2023 influenza season, putting a strain on health care resources. As the 2023 to 2024 season begins, internal medicine physicians and other health care professionals play an important role in communicating the benefits of vaccinations against influenza and other respiratory viruses, say members of the Influenza Division of the Centers for Disease Control and Prevention (CDC).  

In their commentary, the authors highlight the importance of physicians communicating the benefit of annual influenza vaccination and offer the SHARE (Share why an influenza vaccine is right for the patient, Highlight positive experiences with influenza vaccines, Address patient questions and any concerns, Remind patients that vaccines help protect them and their loved ones, and Explain the potential costs of getting influenza) method to help healthcare professionals clearly communicate with patients.  

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Mark W. Tenforde, MD, PhD, MPH, DTM&H, please contact media@cdc.gov.